Trazodone is an antidepressant, in the drug class commonly known as Serotonin Agonist and Reuptake Inhibitor (SARI). The drug is one of the most popular in the world, and the 24th most-prescribed drug in the United States, with over 25 million prescriptions issued in 2018. While commonly used as an antidepressant, Trazodone is also a light sedative, commonly used to self-medicate for off-label reasons including alcohol dependence, pain, OCD, schizophrenia, and even erectile dysfunction.
Trazodone is effective and useful as a medication. It helps millions of people to manage depression and anxiety. However, if you or a loved one is using it, you likely want to know more. This article covers what Trazodone is as well as its potential side-effects, potential for abuse, and what you can and cannot do with the drug.
What is Trazodone Used For?
Trazodone is a SARI-class drug, meaning that it impedes the reuptake of serotonin, effectively increasing the amount of serotonin available in the brain. Trazodone functions differently than many other medications in that it has some (weak) SSRI (Selective serotonin reuptake) properties, but with different side-effects and more of a sedative effect. This makes it an effective treatment for many people struggling with serotonin related mood disorders such as depression and anxiety.
Trazodone may also be used as a light sleeping aid, although prescription use for this purpose is rare.
Is Trazodone Addictive?
Trazodone has a light risk of abuse, but lower than other antidepressants such as Ambien. However, individuals who use Trazodone for periods of 6-8 weeks are likely to develop light physical dependence. Users may also develop stronger psychological dependence over time, especially because withdrawal symptoms and anxiety/depression rebound are likely to occur when quitting the drug.
Physical Dependence – Individuals develop physical dependence to a drug after the body adjusts to its presence. Trazodone changes the physical volume of serotonin present in the brain. The brain will adapt to this and adjust its own product and serotonin reuptake. Removing the drug will force the brain to re-adjust to normal production levels, which will cause withdrawal symptoms in most after 6-8 weeks of normal use. Trazodone also causes dose-dependent results, meaning that a higher dose will cause stronger withdrawal symptoms. This is typically part of Antidepressant Discontinuation Syndrome (ADS)
Psychological Dependence – Psychological dependence occurs when individuals convince themselves they need a drug to function. Persons with trauma and anxiety are especially prone to psychological dependence because they are more likely to induce anxiety or panic because they don’t have a drug to ensure that they don’t. This dependence may eventually result in a full addiction, but in the case of Trazodone, is unlikely.
While the indicators for abuse will vary a great deal depending on the individual, you can consider a few recurring factors:
- The individual does not have a prescription but uses trazodone anyway
- The individual uses trazodone outside of their prescription or more than they are prescribed
- They take trazodone with alcohol or other drugs, snort it, or inject it
- They use trazodone before operating heavy machinery or in situations where it might otherwise negatively affect their safety or that of others
- They continue to use trazodone despite negative side-effects or repercussions
- They continuously talk about, think about, or have trazodone with them despite not needing it
- They doctor shop and have prescriptions from multiple doctors
If you suspect your loved one of abusing trazodone, it’s important to talk to them and to attempt to get them help.
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Antidepressant Discontinuation Syndrome
ADS is a form of substance dependence produced as a result of long-term exposure to an antidepressant medication. Under the DSM V, it incorporates tolerance and withdrawal, where individuals experience negative side effects when quitting but also have to take a higher dose to produce any or the same effects. Most people who take Trazodone for more than 6-8 weeks will experience ADS.
Symptoms can include:
- Depression or depressive mood swings
- Cold and flu symptoms
- Nausea, diarrhea, potential vomiting
- Insomnia or sleep issues and vivid dreams
Most individuals will recover from ADS after a period of 4-14 days, although severity heavily depends on the dose. The best mitigation strategy is to quit Trazodone after a consultation with your doctor, potentially after following a tapering schedule to reduce the normal dosage of the drug. This weaning process reduces the likelihood and severity of ADS symptoms by allowing the body to adapt to having less Trazodone in the system over time.
Individuals suffering from extreme anxiety, very strong depression, or schizophrenia are strongly recommended to seek out detox and medical monitoring for the duration. Because most Trazodone users take the drug for these reasons, it’s almost always a good idea to detox in a safe, medical environment. Why? Persons with existing mental disorders are more likely to be prone to self-harm, trauma, and suicidal ideation during withdrawal.
Dangers of Trazodone Abuse
While Trazodone is unlikely to produce a full addiction on the DSM-V scale, it is likely to cause harm to the individual in numerous ways. Trazodone is a light sedative, it does impact the brain, and it does impact how an individual thinks and reacts. Over time, this will result in negative physical and well as psychological side effects, some of which can be semi-permanent or permanent.
Suicidal Tendencies – Trazodone may increase the risk of suicidal tendencies and actions, especially during periods of abuse. A larger dose increases the risk of suicidal ideation.
Sedation – Trazodone is a light sedative and will impair vigilance as well as the ability to utilize motor skills. Individuals abusing Trazodone should not operate motor vehicles.
Heart – Trazodone is known to increase the risk of cardiac arrythmia. Individuals with a weak heart, previous heart issues, or genetic susceptibility are at risk when abusing the drug.
Liver Damage – Trazodone interacts with liver enzymes such as CYP3A4, which can cause additional stress and potential liver damage or failure over periods of long or heavy abuse.
In most cases, the severity of side effects heavily depends on genetics, metabolism and weight, volume of abuse, and duration of abuse.
If you or a loved one is struggling with Trazodone abuse, it’s important to get help. Trazodone is a prescription medication but it can be extremely harmful when taken outside of a prescription, with other medication, or in a very large dose.
In most cases, detox, or the process of medically controlling withdrawal to minimize symptoms and risks, will last for 1-2 weeks and will include follow-up treatment for both psychological reliance on medication and to help individuals combat cravings, develop coping mechanisms, and learn how to live a happy and healthy life without depending on a substance. However, this should most-often be followed up with extensive therapy to treat the underlying disorder, which will likely come back or even worsen without Trazodone. In many cases, you or your loved one may have to move to an alternative prescription treatment for depression or anxiety, which means carefully detoxing and working with your doctor to determine the next best steps, possibly following a dual-diagnosis rehabilitation program to treat addiction, and working with therapists to ensure you can manage your depression or anxiety at the same time.
Consult with your doctor or physician or seek out help through a detox center to get help.